POLICE APPLICANT PRE-EMPLOYMENT INTERVIEW NAME OF APPLICANT FIRST MIDDLE LAST ADDRESS STREET AND NUMBER CITY AND STATE DATE AGE OF BIRTH CITY/STATE OF BIRTH BY COMPLETING AND SIGNING THIS INTERVIEW FORM, I COMPLETELY UNDERSTAND THAT AN EXTENSIVE BACKGROUND INVESTIGATION WILL BE CONDUCTED BY THE GREENVILLE POLICE DEPARTMENT. T:\Forms\Pre Employment Invterview.doc 1 PER
A. PERSONAL HISTORY 1. Have you ever used another name, besides a nickname? Give name 2. Have you falsified any statement on the Personal History Form? 3. Have you left any information off of your Personal History Form? 4. Have you left any relatives called for off of your Personal History Form? 5, Have you been "coached" or told what to tell or not to tell to get this job? B. PERSONAL AND MARITAL INFORMATION 1. Have you ever been married? 2. Are you now divorced? 3. Have you been married more than once? 3. Are you paying alimony or child support? 4. Do you have a common-law marriage? 5. Are you avoiding payments to your former husband/wife or children? 6. Have you ever been ordered into court for non-payment of alimony or child support? 7. Have you discussed this job with your husband/wife? 8. Does he/she want you to get into this type of work? If answer is "NO", give explanation. 9. Are you now living at the address shown on your application? T:\Forms\Pre Employment Invterview.doc 2 PER
C. WORK RECORD AND BACKGROUND INFORMATION 1. Have you ever been rejected for employment with any Police Department, Probation Office, Juvenile Office, Sheriffs Office, Correctional Office or any type of Federal or State law enforcement agency? 2. Do you now have applications on file or pending with any other Police Departments? 3. Do you now have applications on file with any type of Correctional or Law Enforcement Agency? 4. Have you ever been fired for any reason from any job? 5. Have you ever quit a job to avoid being fired? 6. Of all the jobs you've had, what is the most serious work related trouble you were in involved in? 7. Have you ever walked off of a job when you got mad or were under pressure? 8. Have you ever quit a job without giving notice? 9. Have you ever used sick leave besides when you were actually sick? 10. Have you ever been reprimanded for reporting late for work? How may times 11. Have you included all previous jobs on the Personal History Statement, both temporary and full time since the age of 16? 12. Have you omitted any jobs because you felt you couldn't get a favorable recommendation? T:\Forms\Pre Employment Invterview.doc 3 PER
D. MILITARY SERVICE INFORMATION 1. Have you ever been in the military service? 2. Were you ever A W O L? 3. Were you ever given company punishment? (Article 15, Summary Article 15, or Captain's Mast) 4. Were you ever confined to the brig or guardhouse? 5. Were you ever under house arrest? 6. Were you ever reduced in rank? 7. Were you ever passed over for rank? 8. Were you ever given a court martial? 9. Give complete explanation for leaving the military. 10. Did you ever sell anything on the black market? E. EMPLOYMENT THEFT 1. Have you ever been accused of stealing any money from a place where you worked? 2. Have you ever been accused of stealing any merchandise, materials or equipment from a place where you worked? 3. Have you ever deliberately converted government property to your own use or sold it? 4. Have you ever sold any merchandise you knew was stolen? 5. Have you ever bought any merchandise you knew was stolen? 6. Have you ever helped another employee steal anything from where you worked? T:\Forms\Pre Employment Invterview.doc 4 PER
F. ARREST AND CRIMINAL ACTIVITY 1. Have you ever been arrested for anything other than routine traffic stops? 2. How many traffic tickets have you received in last 5 years? 3. Have you ever been questioned by the police for a suspected offense? 4. Have you ever helped or been with anyone when they stole anything? 6. Have you ever been finger-printed? When? Why? 7. Have you ever been involved in any of the below, either alone or with someone else? (a) (b) (c) (d) (e) (f) (g) (h) Ever steal anything? Ever steal anything from someone's house? Ever take part in a crime using a gun or knife? Ever broken into any house or business? Ever forced anyone to commit a sex act? Ever attempted to kill anyone? Ever unlawfully set fire to anything on purpose? Ever unlawfully damaged anyone's property on purpose? 8. Have you ever committed any other crime not previously discussed? T:\Forms\Pre Employment Invterview.doc 5 PER
G. TRAFFIC INFORMATION 1. Have you had moving traffic violation tickets in other cities or states that you have not previously told us about? 2. Have you ever had a driver's license suspension? 3. Do you have any old unpaid traffic tickets? non-traffic tickets? parking tickets? 4. Do you have auto liability insurance on your car? 5. Have you ever had a wreck and left without leaving your identification? 6. Have you ever been sued as the result of a traffic matter? 7. Have you ever been pursued by the police in a car? Driver? Passenger? 8. What is the most number of traffic accidents that you have been involved in, as a driver, whether you were at fault or not and whether a police report was made or not? T:\Forms\Pre Employment Invterview.doc 6 PER
H. DRINKING HABITS 1. Do you drink alcoholic beverages occasionally? I. DRUG INFORMATION 1. Do you currently use illegal drugs? 2. Do you currently use prescription drugs? J. CREDIT INFORMATION (GAMBLING) 1. Have you ever had any bad credit? 2. Do you have any bad credit now? 3. Have you ever been refused credit by a bank or store for any reason besides being too young or not having credit? 4. Have you ever been threatened with a law suit because of bills? 5. Are you behind on any bills now? 6. Have you ever skipped out on a bill anywhere? 7. Do you owe more money per month than you make per month? 8. Do you have any debts, bills or owe any money in your name or anyone else's, that you did not list on your Personal History Forms? 9. Have you ever had a check bounce? Last Time? 10. Do you have any income from another source besides your employment? 11. Does your husband/wife have any bills in her/his name not shown on your written form? 12. Have you ever been evicted from an apartment or house? 13. Have your ever gambled? (Explain to what degree how many times, amounts, etc.?) T:\Forms\Pre Employment Invterview.doc 7 PER
K. SEXUALLY RELATED ACTIVITIES 1. Have you ever sexually fondled or abused a child or minor? 2. Have you ever committed the offense of indecent exposure? 3. Have you ever been a participant in any sexual act with an animal or fowl? 4. Have you ever procured the services of a prostitute? 5. Have you ever engaged in or been accused of prostitution? 6. Have you ever peeked or been accused of peeking into a window for the purpose of sexual gratification? L. SUBVERSIVE ACTIVITIES 1. To your knowledge, has any member of your family or husband/wife's family been a member of or associated with any subversive or militant organization or group? 2. Have you ever associated with persons who advocated the overthrow of the government by force or violence? 3. Have you ever knowingly attended such a group's meetings? 4. Have you ever been refused a security clearance by the government? 5. Have you ever knowingly violated a government security clearance? 6. Have you ever been hypnotized by any person? 7. Have you ever been a member of any campus militant organization? 8. Have you ever taken part in a riot as a rioter? T:\Forms\Pre Employment Invterview.doc 8 PER
M. ADDITIONAL INFORMATION 1. Have you ever killed or drowned an animal other than hunting? 2. Did you ever get a "kick" or thrill out of hurting someone smaller than you? 3. Have you ever enjoyed inflicting pain on anything or anyone? 4. Have you ever enjoyed seeing another person suffer? 5. Do you enjoy taking part in a fight? 6. Do you feel like your are a coward? Have you ever run from a fight? 7. Do you doubt that you could fight in the line of duty as an officer? 8. Does the thought of working alone as a police officer bother you? 9. Could you take a human life as an officer? 10. Do you think you might abuse your power as an officer? N. REASONS FOR APPLYING 1. Why did you choose this department to seek employment? ` 2. Have you been "coached" or told what to tell or not to tell to get this job? T:\Forms\Pre Employment Invterview.doc 9 PER
I hereby certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information shall be grounds for refusal to hire or, if hired, termination. Signature of Applicant Sworn and subscribed before me, a Notary Public, in and for the State of, this the day of,. Notary Public Printed Name My Commission Expires T:\Forms\Pre Employment Invterview.doc 10 PER